General Topics

What Is A Pediatric Dentist?

The pediatric dentist has an extra two to three
years of specialized training after dental school,
and is dedicated to the oral health of children from
infancy through the teenage years. The very young,
pre-teens, and teenagers all need different
approaches in dealing with their behavior, guiding
their dental growth and development, and helping
them avoid future dental problems. The pediatric
dentist is best qualified to meet these needs.

Why Are The Primary Teeth Important?

It is very important to maintain the health of
the primary teeth. Neglected cavities can and
frequently do lead to problems which affect
developing permanent teeth. Primary teeth, or baby
teeth are important for (1) proper chewing and
eating, (2) providing space for the permanent teeth
and guiding them into the correct position, and (3)
permitting normal development of the jaw bones and
muscles. Primary teeth also affect the development
of speech and add to an attractive appearance. While
the front 4 teeth last until 6-7 years of age, the
back teeth (cuspids and molars) aren't replaced
until age 10-13.

Eruption Of Your Child's Teeth

Children’s teeth begin forming before birth. As early as 4 months,
the first primary (or baby) teeth to erupt through the gums are the
lower central incisors, followed closely by the upper central
incisors. Although all 20 primary teeth usually appear by age 3, the
pace and order of their eruption varies.

Permanent teeth begin appearing around age 6, starting with the
first molars and lower central incisors. At the age of 8, you can generally expect the bottom 4 primary teeth (lower central and lateral incisors) and the top 4 primary teeth (upper central and lateral incisors) to be gone and permanent teeth to have taken their place. There is about a one to two year break from ages 8-10 and then the rest of the permanent teeth will start to come in. This process continues until
approximately age 21.

Adults have 28 permanent teeth, or up to 32 including the third
molars (or wisdom teeth).

Dental Emergencies

Toothache:
Clean the area of the affected tooth. Rinse the
mouth thoroughly with warm water or use dental floss
to dislodge any food that may be impacted. If the
pain still exists, contact your child's dentist. Do
not place aspirin or heat on the gum or on the
aching tooth. If the face is swollen, apply cold
compresses and contact your dentist immediately.

Cut or Bitten Tongue, Lip or Cheek: Apply
ice to injured areas to help control swelling. If
there is bleeding, apply firm but gentle pressure
with a gauze or cloth. If bleeding cannot be
controlled by simple pressure, call a doctor or
visit the hospital emergency room.

Knocked Out Permanent Tooth: If possible,
find the tooth. Handle it by the crown, not by the
root. You may rinse the tooth with water only. DO
NOT clean with soap, scrub or handle the tooth
unnecessarily. Inspect the tooth for fractures. If
it is sound, try to reinsert it in the socket. Have
the patient hold the tooth in place by biting on a
gauze. If you cannot reinsert the tooth, transport
the tooth in a cup containing the patient's saliva
or milk. If the patient is old enough, the tooth may
also be carried in the patient's mouth (beside the
cheek). The patient must see a dentist IMMEDIATELY!
Time is a critical factor in saving the tooth.

Knocked Out Baby Tooth: Contact your
pediatric dentist during business hours. This is not
usually an emergency, and in most cases, no
treatment is necessary.

Chipped or Fractured Permanent Tooth:
Contact your pediatric dentist immediately. Quick
action can save the tooth, prevent infection and
reduce the need for extensive dental treatment.
Rinse the mouth with water and apply cold compresses
to reduce swelling. If possible, locate and save any
broken tooth fragments and bring them with you to
the dentist.

Chipped or Fractured Baby Tooth: Contact
your pediatric dentist.

Severe Blow to the Head: Take your child
to the nearest hospital emergency room immediately.

Possible Broken or Fractured Jaw: Keep the
jaw from moving and take your child to the nearest
hospital emergency room.

Dental Radiographs (X-Rays)

Radiographs (X-Rays) are a vital and necessary
part of your child's dental diagnostic process.
Without them, certain dental conditions can and will
be missed.

Radiographs detect much more than cavities. For
example, radiographs may be needed to survey
erupting teeth, diagnose bone diseases, evaluate the
results of an injury, or plan orthodontic treatment.
Radiographs allow dentists to diagnose and treat
health conditions that cannot be detected during a
clinical examination. If dental problems are found
and treated early, dental care is more comfortable
for your child and more affordable for you.

The American Academy of Pediatric Dentistry
recommends radiographs and examinations every six
months for children with a high risk of tooth decay.
On average, most pediatric dentists request
radiographs approximately once a year. Approximately
every 3 years, it is a good idea to obtain a
complete set of radiographs, either a panoramic and
bitewings or periapicals and bitewings.

Pediatric dentists are particularly careful to
minimize the exposure of their patients to
radiation. With contemporary safeguards, the amount
of radiation received in a dental X-ray examination
is extremely small. The risk is negligible. In fact,
the dental radiographs represent a far smaller risk
than an undetected and untreated dental problem.
Lead body aprons and shields will protect your
child. Today's equipment filters out unnecessary
x-rays and restricts the x-ray beam to the area of
interest. High-speed film and proper shielding
assure that your child receives a minimal amount of
radiation exposure.

What's The Best Toothpaste For My Child?

Tooth
brushing is one of the most important tasks for good
oral health. Many toothpastes, and/or tooth
polishes, however, can damage young smiles. They
contain harsh abrasives, which can wear away young
tooth enamel. When looking for a toothpaste for your
child, make sure to pick one that is recommended by
the American Dental Association as shown on the box
and tube. These toothpastes have undergone testing
to insure they are safe to use.

Remember, children should spit out toothpaste
after brushing to avoid getting too much fluoride.
If too much fluoride is ingested, a condition known
as fluorosis can occur. If your child is too young
or unable to spit out toothpaste, consider providing
them with a fluoride free toothpaste, using no
toothpaste, or using only a "pea size" amount of
toothpaste.

Does Your Child Grind His Teeth At Night? (Bruxism)

Parents are often concerned about the nocturnal
grinding of teeth (bruxism). Often, the first
indication is the noise created by the child
grinding on their teeth during sleep. Or, the parent
may notice wear (teeth getting shorter) to the
dentition. One theory as to the cause involves a
psychological component. Stress due to a new
environment, divorce, changes at school; etc. can
influence a child to grind their teeth. Another
theory relates to pressure in the inner ear at
night. If there are pressure changes (like in an
airplane during take-off and landing, when people
are chewing gum, etc. to equalize pressure) the
child will grind by moving his jaw to relieve this
pressure.

The majority of cases of pediatric bruxism do not
require any treatment. If excessive wear of the
teeth (attrition) is present, then a mouth guard
(night guard) may be indicated. The negatives to a
mouth guard are the possibility of choking if the
appliance becomes dislodged during sleep and it may
interfere with growth of the jaws. The positive is
obvious by preventing wear to the primary dentition.

The good news is most children outgrow bruxism.
The grinding decreases between the ages 6-9 and
children tend to stop grinding between ages 9-12. If
you suspect bruxism, discuss this with your
pediatrician or pediatric dentist.

Thumb
Sucking

Sucking
is a natural reflex and infants and young children
may use thumbs, fingers, pacifiers and other objects
on which to suck. It may make them feel secure and
happy, or provide a sense of security at difficult
periods. Since thumb sucking is relaxing, it may
induce sleep.

Thumb sucking that persists beyond the eruption
of the permanent teeth can cause problems with the
proper growth of the mouth and tooth alignment. How
intensely a child sucks on fingers or thumbs will
determine whether or not dental problems may result.
Children who rest their thumbs passively in their
mouths are less likely to have difficulty than those
who vigorously suck their thumbs.

Children should cease thumb sucking by the time
their permanent front teeth are ready to erupt.
Usually, children stop between the ages of two and
four. Peer pressure causes many school-aged children
to stop.

Pacifiers are no substitute for thumb sucking.
They can affect the teeth essentially the same way
as sucking fingers and thumbs. However, use of the
pacifier can be controlled and modified more easily
than the thumb or finger habit. If you have concerns
about thumb sucking or use of a pacifier, consult
your pediatric dentist.

A few suggestions to help your child get through
thumb sucking:

Children often suck their thumbs when
feeling insecure. Focus on correcting the cause
of anxiety, instead of the thumb sucking.

Children who are sucking for comfort will
feel less of a need when their parents provide
comfort.

Reward children when they refrain from
sucking during difficult periods, such as when
being separated from their parents.

Your pediatric dentist can encourage
children to stop sucking and explain what could
happen if they continue.

If these approaches don't work, remind the
children of their habit by bandaging the thumb
or putting a sock on the hand at night. Your
pediatric dentist may recommend the use of a
mouth appliance.

What Is
Pulp Therapy?

The pulp of a tooth is the inner, central core of
the tooth. The pulp contains nerves, blood vessels,
connective tissue and reparative cells. The purpose
of pulp therapy in Pediatric Dentistry is to
maintain the vitality of the affected tooth (so the
tooth is not lost).

Dental caries (cavities) and traumatic injury are
the main reasons for a tooth to require pulp
therapy. Pulp therapy is often referred to as a
"nerve treatment", "children's root canal",
"pulpectomy" or "pulpotomy". The two common forms of
pulp therapy in children's teeth are the pulpotomy
and pulpectomy.

A pulpotomy removes the diseased pulp tissue
within the crown portion of the tooth. Next, an
agent is placed to prevent bacterial growth and to
calm the remaining nerve tissue. This is followed by
a final restoration (usually a stainless steel
crown).

A pulpectomy is required when the entire pulp is
involved (into the root canal(s) of the tooth).
During this treatment, the diseased pulp tissue is
completely removed from both the crown and root. The
canals are cleansed, disinfected and, in the case of
primary teeth, filled with a resorbable material.
Then, a final restoration is placed. A permanent
tooth would be filled with a non-resorbing material.

Adult Teeth
Coming in Behind Baby Teeth

This
is a very common occurrence with children, usually
the result of a lower, primary (baby) tooth not
falling out when the permanent tooth is coming in.
In most cases if the child starts wiggling the baby
tooth, it will usually fall out on its own within
two months. If it doesn't, then contact your
pediatric dentist, where they can easily remove the
tooth. The permanent tooth should then slide
into the proper place.

Early Infant Oral Care

Perinatal & Infant Oral Health

The
American Academy of Pediatric Dentistry (AAPD)
recommends that all pregnant women receive oral
healthcare and counseling during pregnancy. Research
has shown evidence that periodontal disease can
increase the risk of preterm birth and low birth
weight. Talk to your doctor or dentist about ways
you can prevent periodontal disease during
pregnancy.

Additionally, mothers with poor oral health may
be at a greater risk of passing the bacteria which
causes cavities to their young children. Mother's
should follow these simple steps to decrease the
risk of spreading cavity-causing bacteria:

Visit your dentist regularly.

Brush and floss on a daily basis to reduce
bacterial plaque.

Proper diet, with the reduction of beverages
and foods high in sugar & starch.

Use a fluoridated toothpaste recommended by
the ADA and rinse every night with an
alocohol-free, over-the-counter mouth rinse with
.05 % sodium fluoride in order to reduce plaque
levels.

Don't share utensils, cups or food which can
cause the transmission of cavity-causing
bacteria to your children.

Use of xylitol chewing gum (4 pieces per day
by the mother) can decrease a child's caries
rate.

Your Child's First Dental Visit-Establishing A
"Dental Home"

The American Academy of Pediatrics (AAP), the
American Dental Association (ADA), and the American
Academy of Pediatric Dentistry (AAPD) all recommend
establishing a "Dental Home" for your child by one
year of age. Children who have a dental home are
more likely to receive appropriate preventive and
routine oral health care.

The Dental Home is
intended to provide a place other than the Emergency
Room for parents.

You can make the first visit to the dentist
enjoyable and positive. If old enough, your child
should be informed of the visit and told that the
dentist and their staff will explain all procedures
and answer any questions. The less to-do concerning
the visit, the better.

It is best if you refrain from using words around
your child that might cause unnecessary fear, such
as needle, pull, drill or hurt. Pediatric dental
offices make a practice of using words that convey
the same message, but are pleasant and
non-frightening to the child.

When Will My Baby Start Getting Teeth?

Teething, the process of baby (primary) teeth
coming through the gums into the mouth, is variable
among individual babies. Some babies get their teeth
early and some get them late. In general, the first
baby teeth to appear are usually the lower front
(anterior) teeth and they usually begin erupting
between the age of 6-8 months. See
"Eruption of Your Child's Teeth" for more
details.

Baby Bottle Tooth Decay (Early Childhood Caries)

One
serious form of decay among young children is baby
bottle tooth decay. This condition is caused by
frequent and long exposures of an infant's teeth to
liquids that contain sugar. Among these liquids are
milk (including breast milk), formula, fruit juice
and other sweetened drinks.

Putting a baby to bed for a nap or at night with
a bottle other than water can cause serious and
rapid tooth decay. Sweet liquid pools around the
child's teeth giving plaque bacteria an opportunity
to produce acids that attack tooth enamel. If you
must give the baby a bottle as a comforter at
bedtime, it should contain only water. If your child
won't fall asleep without the bottle and its usual
beverage, gradually dilute the bottle's contents
with water over a period of two to three weeks.

After each feeding, wipe the baby's gums and
teeth with a damp washcloth or gauze pad to remove
plaque. The easiest way to do this is to sit down,
place the child's head in your lap or lay the child
on a dressing table or the floor. Whatever position
you use, be sure you can see into the child's mouth
easily.

Sippy
Cups

Sippy cups should be used as a training tool from
the bottle to a cup and should be discontinued by
the first birthday. If your child uses a sippy cup
throughout the day, fill the sippy cup with water
only (except at mealtimes). By filling the sippy cup
with liquids that contain sugar (including milk,
fruit juice, sports drinks, etc.) and allowing a
child to drink from it throughout the day, it soaks
the child's teeth in cavity causing bacteria.

Prevention

Care Of Your Child's Teeth

Brushing Tips:

Starting at birth, clean your child's gums with a soft cloth and water.

As soon as your child's teeth erupt, brush them with a soft-bristled toothbrush.

If they are under the age of 2, use a small "smear" of toothpaste.

If they're 2-5 years old, use a "pea-size" amount of toothpaste.

Be sure and use an ADA-accepted fluoride toothpaste and make sure your child does not swallow it.

When brushing, the parent should brush the child's teeth until they are old enough to do a good job on their own.

Flossing Tips:

Flossing removes plaque between teeth and under the gumline where a toothbrush can't reach.

Flossing should begin when any two teeth touch.

Be sure and floss your child's teeth daily until he or she can do it alone.

Good Diet = Healthy Teeth

Healthy
eating habits lead to healthy teeth. Like the rest
of the body, the teeth, bones and the soft tissues
of the mouth need a well-balanced diet. Children
should eat a variety of foods from the five major
food groups. Most snacks that children eat can lead
to cavity formation. The more frequently a child
snacks, the greater the chance for tooth decay. How
long food remains in the mouth also plays a role.
For example, hard candy and breath mints stay in the
mouth a long time, which cause longer acid attacks
on tooth enamel. If your child must snack, choose
nutritious foods such as vegetables, low-fat yogurt,
and low-fat cheese, which are healthier and better
for children's teeth.

How Do I Prevent Cavities?

Good oral hygiene removes bacteria and the left
over food particles that combine to create cavities.
For infants, use a wet gauze or clean washcloth to
wipe the plaque from teeth and gums. Avoid putting
your child to bed with a bottle filled with anything
other than water. See "Baby
Bottle Tooth Decay" for more information.

For older children, brush their teeth at least
twice a day. Also, watch the number of snacks
containing sugar that you give your children.

The American Academy of Pediatric Dentistry
recommends visits every six months to the pediatric
dentist, beginning at your child's first birthday.
Routine visits will start your child on a lifetime
of good dental health.

Your pediatric dentist may also recommend
protective sealants or home fluoride treatments for
your child. Sealants can be applied to your child's
molars to prevent decay on hard to clean surfaces.

Seal
Out Decay

A sealant is a protective coating that is applied
to the chewing surfaces (grooves) of the back teeth
(premolars and molars), where four out of five
cavities in children are found. This sealant acts as
a barrier to food, plaque and acid, thus protecting
the decay-prone areas of the teeth.

Before Sealant Applied

After Sealant Applied

Fluoride

Fluoride is an element, which has been shown to
be beneficial to teeth. However, too little or too
much fluoride can be detrimental to the teeth.
Little or no fluoride will not strengthen the teeth
to help them resist cavities. Excessive fluoride
ingestion by preschool-aged children can lead to
dental fluorosis, which is a chalky white to even
brown discoloration of the permanent teeth. Many
children often get more fluoride than their parents
realize. Being aware of a child's potential sources
of fluoride can help parents prevent the possibility
of dental fluorosis.

Some of these sources are:

Too much fluoridated toothpaste at an early
age.

The inappropriate use of fluoride
supplements.

Hidden sources of fluoride in the child's
diet.

Two and three year olds may not be able to
expectorate (spit out) fluoride-containing
toothpaste when brushing. As a result, these
youngsters may ingest an excessive amount of
fluoride during tooth brushing. Toothpaste ingestion
during this critical period of permanent tooth
development is the greatest risk factor in the
development of fluorosis.

Excessive and inappropriate intake of fluoride
supplements may also contribute to fluorosis.
Fluoride drops and tablets, as well as fluoride
fortified vitamins should not be given to infants
younger than six months of age. After that time,
fluoride supplements should only be given to
children after all of the sources of ingested
fluoride have been accounted for and upon the
recommendation of your pediatrician or pediatric
dentist.

Parents can take the following steps to decrease
the risk of fluorosis in their children's teeth:

Use baby tooth cleanser on the toothbrush of
the very young child.

Place only a pea sized drop of children's
toothpaste on the brush when brushing.

Account for all of the sources of ingested
fluoride before requesting fluoride supplements
from your child's physician or pediatric
dentist.

Avoid giving any fluoride-containing
supplements to infants until they are at least 6
months old.

Obtain fluoride level test results for your
drinking water before giving fluoride
supplements to your child (check with local
water utilities).

Mouth
Guards

When
a child begins to participate in recreational
activities and organized sports, injuries can occur.
A properly fitted mouth guard, or mouth protector,
is an important piece of athletic gear that can help
protect your child's smile, and should be used
during any activity that could result in a blow to
the face or mouth.

Mouth guards help prevent broken teeth, and
injuries to the lips, tongue, face or jaw. A
properly fitted mouth guard will stay in place while
your child is wearing it, making it easy for them to
talk and breathe.

Xylitol - Reducing
Cavities

The American Academy of Pediatric Dentistry
(AAPD) recognizes the benefits of xylitol on the
oral health of infants, children, adolescents, and
persons with special health care needs.

The use of XYLITOL GUM by mothers (2-3 times per
day) starting 3 months after delivery and until the
child was 2 years old, has proven to reduce cavities
up to 70% by the time the child was 5 years old.

Studies using xylitol as either a sugar
substitute or a small dietary addition have
demonstrated a dramatic reduction in new tooth
decay, along with some reversal of existing dental
caries. Xylitol provides additional protection that
enhances all existing prevention methods. This
xylitol effect is long-lasting and possibly
permanent. Low decay rates persist even years after
the trials have been completed.

Xylitol is widely distributed throughout nature
in small amounts. Some of the best sources are
fruits, berries, mushrooms, lettuce, hardwoods, and
corn cobs. One cup of raspberries contains less than
one gram of xylitol.

Studies suggest xylitol intake that consistently
produces positive results ranged from 4-20 grams per
day, divided into 3-7 consumption periods. Higher
results did not result in greater reduction and may
lead to diminishing results. Similarly, consumption
frequency of less than 3 times per day showed no
effect.

Beware of
Sports Drinks

Due
to the high sugar content and acids in sports
drinks, they have erosive potential and the ability
to dissolve even fluoride-rich enamel, which can
lead to cavities.

To minimize dental problems, children should
avoid sports drinks and hydrate with water before,
during and after sports. Be sure to talk to
your pediatric dentist before using sports drinks.

If sports drinks are consumed:

reduce the frequency and contact time

swallow immediately and do not swish them
around the mouth

neutralize the effect of sports drinks by
alternating sips of water with the drink

rinse mouthguards only in water

seek out dentally friendly sports drinks

Adolescent Dentistry

Tongue Piercing - Is It Really Cool?

You might not be surprised anymore to see people
with pierced tongues, lips or cheeks, but you might
be surprised to know just how dangerous these
piercings can be.

There are many risks involved with oral
piercings, including chipped or cracked teeth, blood
clots, blood poisoning, heart infections, brain
abscess, nerve disorders (trigeminal neuralgia),
receding gums or scar tissue. Your mouth contains
millions of bacteria, and infection is a common
complication of oral piercing. Your tongue could
swell large enough to close off your airway!

Common symptoms after piercing include pain,
swelling, infection, an increased flow of saliva and
injuries to gum tissue. Difficult-to-control
bleeding or nerve damage can result if a blood
vessel or nerve bundle is in the path of the needle.

So follow the advice of the American Dental
Association and give your mouth a break - skip the
mouth jewelry.

Tobacco - Bad News
In Any Form

Tobacco in any form can jeopardize your child's
health and cause incurable damage. Teach your child
about the dangers of tobacco.

Smokeless tobacco, also called spit, chew or
snuff, is often used by teens who believe that it is
a safe alternative to smoking cigarettes. This is an
unfortunate misconception. Studies show that spit
tobacco may be more addictive than smoking
cigarettes and may be more difficult to quit. Teens
who use it may be interested to know that one can of
snuff per day delivers as much nicotine as 60
cigarettes. In as little as three to four months,
smokeless tobacco use can cause periodontal disease
and produce pre-cancerous lesions called
leukoplakias.

If your child is a tobacco user you should watch
for the following that could be early signs of oral
cancer:

A sore that won't heal.

White or red leathery patches on the lips,
and on or under the tongue.

Pain, tenderness or numbness anywhere in the
mouth or lips.

Difficulty chewing, swallowing, speaking or
moving the jaw or tongue; or a change in the way
the teeth fit together.

Because the early signs of oral cancer usually
are not painful, people often ignore them. If it's
not caught in the early stages, oral cancer can
require extensive, sometimes disfiguring, surgery.
Even worse, it can kill.

Help your child avoid tobacco in any form. By
doing so, they will avoid bringing cancer-causing
chemicals in direct contact with their tongue, gums
and cheek.